From Deanna Miller, Point of Care Testing (POCT) Coordinator at Children’s of Alabama:
We have recently merged our extracorporeal membrane oxidation (ECMO) team with the cardiovascular team from the University of Alabama at Birmingham (UAB) and we are doing all pediatric cardiovascular cases at Children’s now. We would like some insight into monitoring coagulation using the activated coagulation time (ACT) and the chromogenic anti-Xa heparin assay.
Deanna and I traded emails on the topic, and it was a pleasure to hear from her, as she is a graduate of UAB’s Medical Technology program and had been a successful student in my hematology and hemostasis classes. Children’s beautiful new facility is right next-door to UAB’s recently built Women’s and Children’s center. Children’s cardiovascular operating room uses the Medtronic HMS Plus, which offers ACTs for both high and moderate-range heparin therapy. Their ECMO service uses both the ACT and the anti-Xa heparin assay, a near-patient test. Although ITC’s Hemochron Signature Elite provides a partial thromboplastin time (PTT), Deanna’s service prefers to continue with the ACT and anti-Xa.
We found an article that addresses correlations among the ACTs from both the Medtronic and the Hemochron and the anti-Xa: Chia S, Van Cott EM, Raffel OC, Jang IK. Comparison of activated clotting times obtained using Hemochron and Medtronic analysers in patients receiving anti-thrombin therapy during cardiac catheterization. Thromb Haemost 2009;101: 535-40.
Deanna also asked for an expert in heparin management of neonates and peds during ECMO. John Olson, MD, PhD, Professor, Vice Chair for Clinical Affairs, University of Texas Health Sciences Center in San Antonio, provided a referral, however, if you know of someone with experience, please send a referral to [email protected] and I will be sure Deanna receives your message.